In this elegant review, Mann discusses the importance of paying attention to the nature of carbohydrate instead of quantity when recommending diets to reduce the risk of type 2 diabetes and cardiovascular disease (CVD). The author emphasizes that intact fruits, vegetables, legumes, and wholegrains are excellent sources of carbohydrate likely to be rich in nonstarch polysaccharides or dietary fibre and other potentially cardioprotective components. Mann also points out that there is no strong, long-term evidence of benefits when nonstarch polysaccharides or other components of wholegrains, fruits, vegetables, and legumes are added to functional and manufactured foods. Furthermore, although low glycemic index foods may confer benefits by lowering total cholesterol and improving glycemic index, it is unclear whether these benefits are independent of the effects of dietary fibre or the fact that low glycemic index foods tend to have intact plant cell walls. Moreover, it is uncertain whether functional and manufactured foods with a low glycemic index provide the same long-term benefits as low glycemic index plant-based foods. The author concludes that failing to emphasize the need for carbohydrate to be derived principally from wholegrain cereals, fruits, vegetables, and legumes may increase lipoprotein-mediated risk of CVD, especially in overweight and obese individuals who are insulin resistant.
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